To intact or not to intact thats the question (year 2008)

[cclman]

I put 2008 as they may have changed or got better since the last posts on this topic. I have 3 weeks to decide if I hace one put in the R eye. I am worried that:

1) I will feeel it?
2) It will come out?
3) It will hurt when in?
4) It will only last months or years?

What is anyones opinion and experience of intacts aka RINGS no matter how bad or good. Thanks for any tips.

[pepepepe]

All are valid worries there, but this may be dispelled if your surgeon has the experience to know in which case to use Intacs and how, quite definitely or to do another treatment which you also would favor. The surgeon with probably one of the most experience - Dr Colin - says this, which I copy below:

OSN SuperSite Top Story 9/14/2008

Expert shows intracorneal rings stable over 10 years

BERLIN — In the 10 years following first implantation, intracorneal rings have been used in 50,000 keratoconus cases worldwide, and 37,000 grafts have been avoided, according to one expert.

"The technique is now pretty standardized, and we have reliable parameters to make the technique successful according to the type, shape and stage of keratoconus," Joseph Colin, MD, said at the European Society of Cataract and Refractive Surgeons meeting here.

Results with intracorneal rings (Intacs, Addition Technology) are generally satisfactory, with 70% to 80% of the patients gaining lines of vision, 20% remaining stable, and only a few decreasing.

Dr. Colin's personal experience shows that results are stable over time. In his first patient, implanted in 1997, the K-max decrease and visual acuity gain has been stable. Of the 65 eyes implanted in the last 8 years, 5 have needed PK.

He added that the use of femtosecond laser has improved the procedure, but the insertion of the segments in the channels can be cumbersome, due to the collagen bridges that the laser does not cut.

Collagen cross-linking can be a complementary technique to Intacs implantation. Sequence and combination of the two procedures should be adapted to single cases, Dr. Colin said.

[jamesar]

Hey cclman,

I had 2 intacs put in my left eye 1.5 years ago. I now have no intacs in my left eye and am only a week out of a 45 minute operation that removed the last intac. Before that, 6 months ago I went under the knife again to get the first intac out as it had started disolving through my cornea and caused me so much pain and mental trauma that to this day I still shudder at the thought. My whole experience with intacs has been very very bad, and everything that could have gone wrong did go wrong. I will tell you this, the surgeons will probably not tell you about the extra things that you have to do once intacs have been put in. That is potentially fluctuating vision, many visits back to optometrists, surgeron etc, constand changes to glasses, possible increased pain with RGP's, photophobia, deep eye pain. All of your four scenarious came true for me, but you may not get any of them and have a great success with intacs. I firmly believe in surgery to help alleviate problems that overtly effect your quality of life, so if you have exuasted other options, maye you should try the intacs. I personally wish I had just got the corneal transplant instead of the intacs. It has been a very traumatic year and a half for me, amainly caused by the intacs. You can also see intacs quite easily, even though they say that isnt so. And when you get a photo taken you will notice the eye with the intac shows up bright red, lol, looks very strange.

As I said, these where my problems and you may not get any of these happen to you, but I think you deserve to know what CAN really go wrong with these intacs, and I wish i had known of it before I opted for them. i wish you luck in any decision you make. One other thought, if you do get it done, make sure you have strong pain killers on standbye the night after your surgery, and take it easy for a whils after.

[cclman]

Hey cclman,

I had 2 intacs put in my left eye 1.5 years ago. I now have no intacs in my left eye and am only a week out of a 45 minute operation that removed the last intac. Before that, 6 months ago I went under the knife again to get the first intac out as it had started disolving through my cornea and caused me so much pain and mental trauma that to this day I still shudder at the thought. My whole experience with intacs has been very very bad, and everything that could have gone wrong did go wrong. I will tell you this, the surgeons will probably not tell you about the extra things that you have to do once intacs have been put in. That is potentially fluctuating vision, many visits back to optometrists, surgeron etc, constand changes to glasses, possible increased pain with RGP's, photophobia, deep eye pain. All of your four scenarious came true for me, but you may not get any of them and have a great success with intacs. I firmly believe in surgery to help alleviate problems that overtly effect your quality of life, so if you have exuasted other options, maye you should try the intacs. I personally wish I had just got the corneal transplant instead of the intacs. It has been a very traumatic year and a half for me, amainly caused by the intacs. You can also see intacs quite easily, even though they say that isnt so. And when you get a photo taken you will notice the eye with the intac shows up bright red, lol, looks very strange.

As I said, these where my problems and you may not get any of these happen to you, but I think you deserve to know what CAN really go wrong with these intacs, and I wish i had known of it before I opted for them. i wish you luck in any decision you make. One other thought, if you do get it done, make sure you have strong pain killers on standbye the night after your surgery, and take it easy for a whils after.

Thanks to Jamesar and Pepe for you very good comments- Jamesar you really did go through hell!!! My wife is expecting a baby in December and I need to be on form to help her (except changing nappies !!) Was yours done by femtosecond laser ?? is supposed to be good. My Czech doctor who speaks perfect English said he can do the R eye in 3 weeks but does not really go in for the old fashioned bedside manner in talking you through it. Hense my relience on the forum and kind people to offer their experience. Do you know anyone who had a good experience of intacts?? My eyes are very sensitive and I fear the worst. I could not stand it, if I could feel it or see it in my eye. If it felt like an insect stuck in my eye like you get when on a bike in the summer it would drive me potty. I understand they come in different thicknesses? is this true? I think the thinner the better!!!!???

Any more thoughts??? are your eyes better now and do you just wear contacts??? Thanks again.

[rosemary johnson]

A thought..... and sorry if this sounds too like my (or your) mother.....
If you don't do the intac now, you can always reschedule it at a later date.
By which time you will have recovered more fromt he CCL anyway..
If you have the intacs now, and anything goes wrong, or if it just takes longer to heal and to get over the extreme light sensitivity of the intac op, than maybe it might for some lucky people -
then you CANNOT reschedule the birth of your child till your eye is fully well again.
Appealing though it may be to see the little one arrive in 20-20 vision - what's the chance of achieving stable vision that soon after the process anyway? - and is it better to be fit and well and active even if a bit more blurry?
Rosemary

[cclman]

A thought..... and sorry if this sounds too like my (or your) mother.....
If you don't do the intac now, you can always reschedule it at a later date.
By which time you will have recovered more fromt he CCL anyway..
If you have the intacs now, and anything goes wrong, or if it just takes longer to heal and to get over the extreme light sensitivity of the intac op, than maybe it might for some lucky people -
then you CANNOT reschedule the birth of your child till your eye is fully well again.
Appealing though it may be to see the little one arrive in 20-20 vision - what's the chance of achieving stable vision that soon after the process anyway? - and is it better to be fit and well and active even if a bit more blurry?
Rosemary

Rosemary,

Perhaps wise words given? You could well be right I could ot it it later and 80% says I will. I have had bad light sensitivity with ccl/cxl it could be worse with an intact and my poor wife has to drive us the 2 hrs there and 2 hrs back being over 7 months pregass. My R, eye the bad one, is OK and glasses help it see better while the left one does most of the hard work the r one sits there sipping a cool drink just enjoying the colours and and soft picture of things, mind you I made it worse by itching it over the last 20 or 30 years!, I suppose its had enough now. I am also tempted to wait, as technology may get better for intacts. I am worried about feeling it and about it bursting out through the cornea in a bid for freedom (worst case situation). Plus if I have probs after the op with it, with a baby at home it could make life impossible. My wife wants me to see better but is nervose of problems as I am. Its kinda - damned if you do now before a baby and damaed if you don' after the baby we only found about all this 3 months ago on th e www!

I half think technology will kick in 10 or 20 years and a better system will be here. I think ccl/cxl may very well help make them stronger and even reverse it a tiny bit!! my L eye has gone UP -1 so its better.

Thanks for good words of advice and I hope your awful probs get better. Don't overdo it and take it slowly till the one with pressure changes that keeps playing up settles.

[Ozfiz]

hey,
i've got a single intac in my right eye for just on two months now, it was fairly light sensitive at first, but since the stitch was removed this has greatly improve.
My eyes are so far different in the stages they are at, that i cannot have glasses or contact lenses to correct vision, as the script for the right eye would be so strong i would prob fall over all the time.

My doctor has warned me that the eye still might reject the eye, or it might not - he says each case is different and its hard to say how each person will react. I personally cannot notice a differnce in my eye sight in that right eye. I had more mapping of my eye last week and it has showed an improvement and as the doctor put it - its done what he wanted it to do. But i cannot read more then the top line of the eye chart, with my left eye closed and no lenses on. (left eye still has 20/20 vision)
I am getting CXL on my right eye in 5 weeks to help strengthen that eye, doctor said it may improve it a tiny bit more, but cannot make guarentees.

Its hard to say whether it will help you, or it want, i would just consider all the options before you go ahead. But if you go ahead, you can have them removed later on.

[cclman]

hi Ozfiz My right eye is also the bad one of the two twins . I will hold fire on an intact till next year if at all. I hope your ones get better, let me know how it gets on on?! Maybe you will put a contact lens on it when its fully healed? I'm still getting over crosslinking I had that done first (both eyes !), where as you are going to have that done after your intact??? I don't see the logic? I think you should have ccl done first wait 3 to 6 months then get an intact but your doc or surgon is doing (or did it) it the other way. Wery intwesting !!! Good luck.

[Ozfiz]

i think the logic behind doing the intac first, is to help correct the shape, then once the new shaped is in place they then do the CXL on the eye to help further strengthen and help the eye retain the new shaped formed by the intac.

i dont think i will get a contact lens for my right as the eyes are too far different, my left has learnt to compensate and i pretty much only see with one eye.

One other thing i have noticed with my intac is sometimes it picks up the light, usually lights below eye level, you will see a curved shaped of light. Annoying at first, but i have learnt to ignore it.

[cclman]

I have read different things here on intacts. People speak of lights, shapes and some can even see the intact in the eye. Like you, I depend mostly on one eye (the left eye) I want an intact in the right but at this time I dont have the time and can't take the risk and agro of it. I hope that technology in intcats may advance in the years to come? that may happen!? We should hope for the best. If I do it, I'll do it next year unless when I go back to see the eye doc on the 13th of Oct he totally convinces me to do it who knows. It is tempting but risky, OK for some and not OK for others.